不同剂量右美托咪定应用于剖宫产术中预防卡前列素氨丁三醇不良反应的对比研究  

EFFECT OF DIFFERENT CONCENTRATIONS OF DEXMEDETOMIDINE ON ADVERSE EFFECTS INDUCED BY CARBOPROST TROMETHAMINE DURING CESAREAN DELIVERY

作　　者：汪灵芝[1] 廖敏[2] 赖永东[1] 何荣芝[1] 

机构地区：[1]广州医科大学附属第二医院,广东广州510260 [2]广东省中医院,广东广州510120

出　　处：《现代医院》2015年第7期18-20,共3页Modern Hospitals

基　　金：国家自然基金项目(编号:81401017);广州市卫生局项目(编号:20141A011083)

摘　　要：目的 观察和比较不同浓度右美托咪定对剖宫产术中卡前列素氨丁三醇引起的不良反应的预防作用。方法 选择2013年11～2014年11月在本院拟在腰硬联合麻醉下行择期剖宫产术孕妇90例,ASA分级Ⅰ-Ⅱ级,采用随机数字表法分为3组,对照组30例,右美托咪定低剂量组30例、右美托咪定高剂量组30例。右美托咪定低剂量组泵注右美托咪定1μg/kg,10 min后以0.3μg·kg/h持续静脉泵注;右美托咪定高浓度组1μg/kg,10 min后以0.6μg·kg/h持续静脉泵注;对照组泵注0.9%氯化钠溶液,均持续至手术结束。监测3组产妇手术总时间、术中输入量、术毕出血量;监测产妇麻醉前（T0）,手术开始前（T1）,使用卡前列素氨丁三醇10 min（T2）及术毕（T3）的平均动脉压、心率、呼吸及血氧饱和度（sPO2）,记录恶心、呕吐、面部潮红、胸腹痛及头痛等不良反应发生率,并记录三组患者术毕RAYSAY镇静评分。结果 3组产妇手术总时间、术中输入量、术毕出血量比较,差异无统计学意义（p〉0.05）。3组产妇各时间点的呼吸和SPO2比较,差异无统计学意义（p〉0.05）;注射卡前列素氨丁三醇后,右美托咪定组产妇的MAP和心率明显比对照组低（p〈0.05）。与对照组相比,右美托咪定组恶心呕吐及胸腹痛等不良反应发生率明显降低。高剂量右美托咪定组与低剂量组相比,不良反应发生率降低（p〈0.05）,且对患者镇静评分无明显影响。结论 右美托咪定可有效减少剖宫产术中卡前列素氨丁三醇注射液所产生的血流动力学波动和身体不良反应,0.6μg·kg/h持续静脉泵注明显优于0.3μg·kg/h。Objective To investigate and compare the inhibitory effect of different concentrations of dexme-detomidine on adverse effects induced by Carboprost Tromethamine during cesarean delivery. Methods Ninety women ASA status Ⅰ and Ⅱ in Labor who requested epidural analgesia were randomly allocated to three groups ： 1 ） control group（ saline infusion） ; 2 ）low cencentration of dexmedetomidine （0.3 μg · kg/h） ; 3 ）high cencentration of dexmedetomidine （0.6 μg · kg/h）. The control group was given saline injection until the end of the operation. The dexmedetomidine group was given dexmedetomidine injection of 1 μg/kg, and following with continuous intravenous injection of dexmedetomidine by 0.3 μg · kg/h or 0.6μg · kg/h. The operation time,fluid complementation volume, bleeding volume, MAP,HR,RR, SPO2 and Ramsay score in three designed groups were monitored. Adverse reaction like nausea, vomiting, flush and headache, chest and abdominal pain were recorded. Results There was no difference in the operation time, fluid complementation volume, bleeding volume between three groups. There was no significant difference in RR, SpO2, scores of Ramsay at each different point of time between three groups, while the MAP and HR in 0.3 μg ·kg/h or 0. 6 μg ·kg/h dexmedetomidine at T2 and T3 was reduced compared with saline infusion group. In comparison with control group, low and high eencentrations of dexmedetomidine markedly reduced adverse effect induced by Carboprost Tromethamine. Futhermore, there was significant difference in suppressing the Carboprost Tromethamine induced adverse effect between pre - infusion with low concentration and high concentration of dexmedetomidine. Conclusion Dexmedetomidine effectively reduce the hemodynamic fluctuations and adverse reactions induced by carboprost tromethamine in cesarean section. Dexmedetomidine infusion speed of 0.6 μg·kg/h was preferential to be recommend to reduce related adverse reactions in comparison with the speed of 0.3 μg· kg/h.

关 键 词：右美托咪定 卡前列素氨丁三醇 剖宫产 

分 类 号：R984[医药卫生—药品]